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N 440

ANTIARRHYTHMICS
Class I-IV. Treat an abnormality in the rhythm of the heart beat.
myocardial conduction.
Class I (I-A I-B)

Usually affects

Class I-A (fast sodium channel blockers)


*procainamide (procan SR) slows the rate of impulse conduction in the atria and
ventricles. Acts by depressing myocardial contractility, excitability and prolonging the
refractory period. Widens the QRS > 25% and prolongs the QT interval. Can be given
IV, IM or PO to treat atrial and ventricular tachycardia and ventricular fibrillation.
Adverse effectsClass-1-B (fast sodium channel blockers)
*Lidocaine (xylocaine) shortens the action potential, increases the electrical threshold
of ventricle during diastole, suppresse automaticity in the Bundle-of-His Purkinje system.
Used to treat ventricular arrhythmias. Bolus dose given undiluted, 25-50 mg/min.
Followed by continuous IV infusion. Monitor for prolonged PR interval and widened
QRS.
Adverse effects:
Class II (beta-adrenergic blockade)
*Esmolol, propranolol - beta-blockers usually used to control excessive sympathetic
stimulation.
Class III (potassium channel blockers)
*amiodorone (cordarone) lengthens the action potential, slows the repolarization
phase, used for life-threatening ventricular arrhythmias, ventricular fibrillation and
tachycardia. Used to convert an atrial fibrillation to normal sinus. Half-life 25-110
days!!! Most toxic of all arrhythmias.
S.E.bradycardia,QT prolongation and photosensitivity.
*Because of possible pulmonary toxicity, its used only in patients with life-threatening
arrhythmias.
Class IV (calcium channel blockers)
*diltiazem (cardizem)
*verapamil (calan) - slows SA and AV conduction.
flutter/fibrillation.

Used to slow rate in atrial

Beta-blockers,diltiazem, and verapamil best at controlling rate. Amiodorone best


at controlling rhythm.

Cardiac glycoside Digoxin-sometimes given to control heart rate in pts. with A. Fib.
Fewer pts. get digoxin since it can cause toxicity and arrhythmias.
Other treatments:
Cardioversion a synchronized electrical current delivered at levels as low as 50 joules.
Drugs used for chemical cardioversionAccording to 2010 AHA data, out-of-hospital cardiac arrest affects 295,000 people
annually. Less than 7% survive, up to 2/3 suffer neurologic impairment. Therapeutic
hypothermia may help to minimize neurologic injury after cardiac arrest. Cooling pt to
89F to 93F for 12-24 hours.
Defibrillation an unsynchronized countershock delivered at 100-200 joules.
ICDs Implantable Cardiac Defibrilllator
Cardiac Ablation -